Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Soc Sci Med. 2021 Feb;270:113630. doi: 10.1016/j.socscimed.2020.113630. Epub 2020 Dec 18.
Iraq has had limited access to healthcare services due to successive conflicts and political turmoil. Since 2018, Iraq has embarked on a new reconstruction process which includes a goal of 100% immunisation against certain diseases in 2030. We aimed to undertake a comprehensive assessment of Iraq's progress towards universal health coverage (UHC) targets that could contribute to Iraq's policy and strategies.
We estimated the coverage of UHC indicators from six nationally representative population-based household surveys in Iraq during 2000-2018. We employed 14 health service indicators and two financial risk protection indicators in our UHC progress assessment. We used a Bayesian hierarchical regression model to estimate the trend and projection of health service indicators.
Improved water sources, adequate sanitation, institutional delivery, skilled birth attendants, and BCG reached the 80% targets in 2018, and are projected to maintain their status in 2030 at national and subnational levels. Family planning needs satisfied, acute respiratory infection treatment for pneumonia, and oral rehydration therapy will be much less than 80% in 2030. 12% of Iraqi households incurred catastrophic health expenditures in 2012, which was a fourfold increase from 2007. Some governorates faced ten- to twentyfold increases in catastrophic health expenditures, for example, from 0.8% to 15.9% in Diala. Approximately 3% of non-poor households became poor due to out-of-pocket (OOP) payments in 2012.
Without proactive strengthening of the healthcare systems, achieving UHC in Iraq by 2030 would be a challenge. Worsened trends were observed in both conflict-affected and underdeveloped areas in health service coverage and financial risk protection. Recovery of GDP spending on health and pre-pooled financing mechanisms should be introduced for OOP payment reduction. Prioritising nationwide primary healthcare services and regulating public-private role-allotment in the health sector are crucial in improving low coverage indicators and decreasing disparities among governorates.
伊拉克由于连续不断的冲突和政治动荡，其医疗服务的获取受到了限制。自 2018 年以来，伊拉克开始了新的重建进程，其中包括到 2030 年实现某些疾病 100%免疫的目标。我们旨在对伊拉克实现全民健康覆盖（UHC）目标的进展进行全面评估，这将有助于伊拉克的政策和战略。
我们评估了 2000-2018 年期间在伊拉克进行的六次全国代表性人口普查家庭调查中 UHC 指标的覆盖率。我们在 UHC 进展评估中使用了 14 项卫生服务指标和 2 项财务风险保护指标。我们使用贝叶斯层次回归模型来估计卫生服务指标的趋势和预测。
到 2018 年，改进的水源、充足的卫生设施、机构分娩、熟练的接生员和卡介苗的覆盖率达到了 80%的目标，并预计在国家和次国家各级在 2030 年保持这一地位。计划生育需求得到满足、急性呼吸道感染治疗肺炎和口服补液治疗在 2030 年将远低于 80%。2012 年，12%的伊拉克家庭发生灾难性卫生支出，是 2007 年的四倍。一些省份面临着灾难性卫生支出增加十倍至二十倍的情况，例如，迪亚拉从 0.8%增加到 15.9%。大约 3%的非贫困家庭因 2012 年的自费支付而变得贫困。
如果不积极加强医疗保健系统，伊拉克到 2030 年实现 UHC 将是一个挑战。在受冲突影响和欠发达地区，卫生服务覆盖范围和财务风险保护方面的趋势都有所恶化。应引入恢复卫生保健支出占国内生产总值的比例和预筹资金机制，以减少自费支付。优先考虑全国初级保健服务，并规范公私部门在卫生部门的角色分配，对于提高低覆盖率指标和减少各省之间的差距至关重要。
